approach to the patient with disorders of sensation

... Fig 52-3) and to formulate a differential diagnosis (Table 52-4) For instance, the finding of scaling papules (present in patients with psoriasis or atopic dermatitis) places the patient in a ... that the erosion is the primary lesion and the redness and scale are secondary, while the correct interpretation would be that the patient has a pruritic eczematous dermatitis with erosions caused ... nevomelanocytic nevus (Fig 52-2) can be difficult to recognize To aid in the interpretation of skin lesions, a variety of descriptive terms have been developed to characterize cutaneous lesions (Tables...

Ngày tải lên: 06/07/2014, 20:20

... configuration of skin lesions formed from coalescing rings or incomplete rings Pruritus: A sensation that elicits the desire to scratch Pruritus is often the predominant symptom of inflammatory skin ... Erosion: Loss of epidermis without an associated loss of dermis Ulcer: Loss of epidermis and at least a portion of the underlying dermis Excoriation: Linear, angular ... epidermal atrophy) Scar: A change in the skin secondary to trauma or inflammation Sites may be erythematous, hypopigmented, or hyperpigmented depending on their age or character Sites on hair-bearing...

Ngày tải lên: 06/07/2014, 20:20

... assess the distribution of the eruption accurately The patient should first be viewed from a distance of about 1.5–2 m (4–6 ft) so that the general character of the skin and the distribution of lesions ... eruption than is a patient with a similar rash limited to the sun-exposed portions of the face Once the distribution of the lesions has been established, the nature of the primary lesion must be ... distribution of lesions often correlates highly with diagnosis (Fig 52-6) For example, a hospitalized patient with a generalized erythematous exanthem is more likely to have a drug eruption than is a patient...

Ngày tải lên: 06/07/2014, 20:20

... The distribution of some common dermatologic diseases and lesions Figure 52-7 Psoriasis This papulosquamous skin disease is characterized by small and large erythematous papules and plaques with...

Ngày tải lên: 06/07/2014, 20:20

... contrast, lesions with a generalized arrangement are common and suggest a systemic etiology Figure 52-9 Erythema multiforme This eruption is characterized by multiple erythematous plaques with a target ... usually represents a hypersensitivity reaction to drugs (e.g., sulfonylamides) or infections (e.g., HSV) (Courtesy of the Yale Resident's Slide Collection; with permission.) Figure 52-10 ...

Ngày tải lên: 06/07/2014, 20:20

... against the surface of the skin and rotated with downward pressure until it penetrates to the subcutaneous tissue The circular biopsy is then lifted with forceps, and the bottom is cut with iris ... History of allergies Presence of photosensitivity Review of systems Family history (particularly relevant for patients with melanoma, atopy, psoriasis, or acne) 10 Social, sexual, or travel history ... suspected The edge of such a lesion is scraped gently with a no 15 scalpel blade, and the removed scale is collected on a glass microscope slide then treated with to drops of a solution of 10–20%...

Ngày tải lên: 06/07/2014, 20:20

... result of loss of melanocytes Patch Tests Patch testing is designed to document sensitivity to a specific antigen In this procedure, a battery of suspected allergens is applied to the patient' s ... best performed by physicians with special expertise in patch testing and is often helpful in the evaluation of patients with chronic dermatitis FURTHER READINGS Dermatology Lexicon Project: www.futurehealth.rochester.edu/dlp2/ ... dressings and allowed to remain in contact with the skin for 48 h The dressings are removed, and the area is examined for evidence of delayed hypersensitivity reactions (e.g., erythema, edema, or...

Ngày tải lên: 06/07/2014, 20:20

... same as the prognosis of the person with aortic stenosis who develops the first symptoms of congestive heart failure (median survival, ~8 months) However, the patient with heart disease ... selection to seek advantage over normal cells in a recapitulation of evolution One consequence of the traitorous behavior of cancer cells is that the patient feels betrayed by his or her body The cancer ... cancer patient feels that he or she, and not just a body part, is diseased The Magnitude of the Problem No nationwide cancer registry exists; therefore, the incidence of cancer is estimated on the...

Ngày tải lên: 07/07/2014, 01:20

... The past medical history may alert the physician to the presence of underlying diseases that may affect the choice of therapy or the side effects of treatment The social history may reveal occupational ... predisposition and point out the need to begin surveillance or other preventive therapy for unaffected siblings of the patient The review of systems may suggest early symptoms of metastatic disease ... 77-3 Patient Management Important information is obtained from every portion of the routine history and physical examination The duration of symptoms may reveal the chronicity of disease The past...

Ngày tải lên: 07/07/2014, 01:20

... is used to define the extent of disease either as localized, as exhibiting spread outside of the organ of origin to regional but not distant sites, or as metastatic to distant sites The most ... categorizes the tumor on the basis of the size of the primary tumor lesion (T1–4, where a higher number indicates a tumor of larger size), the presence of nodal involvement (usually N0 and N1 for the ... be done at the time of definitive surgical resection of the primary tumor Knowledge of the predilection of particular tumors for spread to adjacent or distant organs helps direct the staging...

Ngày tải lên: 07/07/2014, 01:20

... also has much to offer the patient for whom curative therapy is no longer an option Often a combination of guilt and frustration over the inability to cure the patient and the pressure of a busy ... defined as the appearance of any new lesion or an increase of >25% in the sum of the products of the perpendicular diameters of all measurable lesions (or an increase of 20% in the sums of the longest ... 81) Tools are now available to minimize the acute toxicity of cancer treatment New symptoms developing in the course of cancer treatment should always be assumed to be reversible until proven otherwise...

Ngày tải lên: 07/07/2014, 01:20

... Pregnancy disease, gonadal germ cell tumor Calcitonin Medullary cancer of the thyroid Catecholamines Pheochromocytoma Oncofetal Antigens Alphafetoprotein Hepatocellular carcinoma, gonadal germ Cirrhosis, ... Neuron-specific enolase Lactate dehydrogenase Small cell cancer of the lung,neuroblastoma Lymphoma, Ewing's sarcoma Hepatitis, hemolytic many others Tumor-Associated Proteins anemia, Prostate-specific ... Carcinoembryonic antigen Adenocarcinomas hepatitis Pancreatitis, of the colon, pancreas, hepatitis, lung, breast, ovary inflammatory bowel disease, smoking Enzymes Prostatic acid Prostate cancer...

Ngày tải lên: 07/07/2014, 01:20

... most patients who are cured of cancer return to normal lives Supportive Care In many ways, the success of cancer therapy depends on the success of the supportive care Failure to control the symptoms ... should strive to keep communications open and nonjudgmental, so that patients are more likely to discuss with the physician what they are actually doing The appearance of unexpected toxicity may ... alternatives are often well educated and may be early in the course of their disease Unsound approaches are usually hawked on the basis of unsubstantiated anecdotes and not only cannot help the patient...

Ngày tải lên: 07/07/2014, 01:20

... which to indicate the severity of the pain The clinical condition is often dynamic, making it necessary to reassess the patient frequently Pain therapy should not be withheld while the cause of ... aseptic necrosis of the femoral head) In 10% of cases, pain is unrelated to cancer or its treatment Assessment of pain requires the methodical investigation of the history of the pain, its location, ... caused by chemotherapy (Chap 81) Its severity can be predicted from the drugs used to treat the cancer Three forms of emesis are recognized on the basis of their timing with regard to the noxious...

Ngày tải lên: 07/07/2014, 01:20

... paracentesis of small volumes of fluid If the underlying malignancy is unresponsive to systemic therapy, peritoneovenous shunts may be inserted Despite the fear of disseminating tumor cells into the circulation, ... may provide more tools in the future as cytokine-mediated mechanisms are further elucidated Psychosocial Support The psychosocial needs of patients vary with their situation Patients undergoing ... survivors have other sets of difficulties Patients may have fears associated with the termination of a treatment they associate with their continued survival Adjustments are required to physical...

Ngày tải lên: 07/07/2014, 01:20

... affected by the diagnosis and is coping with it is an important goal of patient management It is best to speak frankly with the patient and the family regarding the likely course of disease These discussions ... acknowledgment of an incurable disease, and the goal of palliative therapy is embraced in the hope of being able to live with disease; finally, at the disclosure of imminent death, another adjustment ... and hope Of course, patients not all progress through all the stages or proceed through them in the same order or at the same rate Nevertheless, developing an understanding of how the patient...

Ngày tải lên: 07/07/2014, 01:20

... subroutine dictates the form of the correspondent to be stored in the normal position of the target T for the final printout A suitable Signal of Peculiarity (δ) is stored in GS The Correspondence ... satellites has the position number 3097 in the 47th block on the 2nd tape To α we attach the tag t and intersort the result with the other contents of the sorting file The entry in the internal ... unpredictable type; otherwise L is raised by unity The designators C, v, and P of the temporary profile TP are revised—in the light of the SC to form the Selected Profile (SP) The status flag v...

Ngày tải lên: 16/03/2014, 19:20

... and all t >0 Proof The proof is similar to that of the proofs of Theorems 4.1 and 5.1 □ Corollary 5.2 Let θ ≥ and let p be a real number with < p 0 Proof The proof is similar to the proof of Theorem 4.1 □ Corollary 4.2 Let X ... |m| − |m|L Proof The proof is similar to the proof of Theorem 3.1 □ Corollary 3.2 Let θ ≥ and p be a real number with p >1 Let f : X ® Y be a mapping satisfying f(0) = and (6) Then, for all x...

Ngày tải lên: 20/06/2014, 22:20

... developed to capture the dynamic characteristics of the problem with consideration to the stochastic nature of the cardholders’ repayments first and secondly to the attrition of accounts and to the ... connect the hidden neuron j to the unique output neuron The sum of their weighted outputs and of a bias term c is used as the input of the final transfer function ϕ2 to compute the output of the unique ... will be used together with the repayments to forecast the profitability and the risk of the cardholder to the credit card issuer The balance payments made by the cardholder are assumed to be conditioned...

Ngày tải lên: 16/09/2015, 14:04

... quasi-likelihood approach only the specification of the marginal mean vector and of the variance requires 11 covariance matrix V of the vector Y of observations Given the moment generating function of the ... that [2] is an extension to mixed models of the structure of &dquo;linear predictors&dquo; originally restricted to fixed effects in the GLM theory: see eg Breslow and Clayton (1992) and Zeger et ... estimates of fixed effects which resembles the so-called mixed model equations of Henderson (1984) The purpose of this note is to show how the GAR procedure can be extended to Poisson variables THEORY...

Ngày tải lên: 14/08/2014, 19:22